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195 W Pike St Suite 203 Lawrenceville GA 30046-4966 | |
| (678) 318-1994 | |
| (678) 377-6080 |
| Full Name | |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 195 W Pike St, Lawrenceville, Georgia |
| Authorized Official Name and Position | Devona M Stalnaker (OWNER) |
| Authorized Official Contact | 6783181994 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
Po Box 1359 Lawrenceville GA 30046-1359 Ph: (678) 318-1994 | 195 W Pike St Suite 203 Lawrenceville GA 30046-4966 Ph: (678) 318-1994 |
| NPI Number | 1053671321 |
|---|---|
| Provider Enumeration Date | 05/21/2012 |
| Last Update Date | 05/21/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1053671321 | NPI | - | NPPES |
| 12183939 | Other | CAQH |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LPC004683 (Georgia) | Primary |
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